Designing a Consumer-Centric Telehealth Experience

Today, with the advent of digital and internet-based technologies, as well as high-speed data transmission and data processing, there is no better time for healthcare organizations to introduce remote telehealth strategies. These strategies can support population health and value-based purchasing and reimbursement, two key drivers of value for providers today. Telehealth has already proven its ability to improve patient outcomes and cut the cost of delivering care. It has become a major component in the success of organizations that are hitting the bullseye by employing the “triple aim” of improving care, improving population health and reducing costs per capita Telehealth comes in many forms, including interactive ones like real-time virtual visits, remote patient monitoring, asynchronous store and forward-later visits. Telemedicine can also be “static,” like educational modules for self-learning, electronic medical records, patient portals and diagnostic algorithms.

The interactive global telehealth market is projected to reach $38 billion by 2022. Recent federal regulatory reforms have resulted in enhanced coverage from both private insurers and under Medicare. For example, Medicare first introduced reimbursable billing codes for telemedicine in 2014, and individual states have also initiated efforts to promote telehealth. In Texas, after facing legal challenges from several in-state medical groups, Gov. Greg Abbott signed Senate Bill 1107, which allows physicians to use video conferencing to treat patients without a prior in-person interaction, as previously required by state physician groups. This pushes consumerism to a new high. With reimbursement tied to value-based payments, the stage is set for new, significantly more convenient and lower-cost access points for consumers to obtain medical treatment and counseling services.

Despite the multiplicity of benefits from telehealth, there has, as was expected, been a lag in adoption. Delays in adopting new technologies are typical in all industries, but adoption is especially challenging in the highly regulated healthcare sector. It has taken years to reach the current inflection point where telemedicine is experiencing almost asymptotic growth in adoption by providers. Scaling up telemedicine strategies requires organizations to be aligned with the needs of key users, have the infrastructure necessary to support telehealth implementation, and reach consensus within the organization that telemedicine can further strategic goals around revenue, patient satisfaction and organizational efficiencies. Given varying state regulations, providers must ensure compliance with local and national regulatory mandates before initiating a telehealth program.

Clinician alignment and buy-in are also imperative, as is an execution plan that paradigms from a design thinking approach, adopting the following five critical design elements:

 

1) DESIGN FOR A COMPASSIONATE PATIENT EXPERIENCE

Telehealth is a proven, viable way to build trust and establish a clinical relationship between patients and providers. Numerous studies have shown that, at least in part, due to its accessibility and lower cost, telehealth can drive clinical outcomes as good as—or superior to—standard medical treatments. To ensure quality, providers must, as a starting point, design the patient experience from a behavioral sciences perspective. This requires a deeper understanding of the user’s interaction with the medical technology so that the patient and doctor can provide input on usability, affordability, accessibility, comfort level, compatibility and emotional satisfaction the services provide. These qualities are the core of the elusive but critical goal of patient engagement. Patient engagement is critical to assuring compliance with treatment plans, as well as program sustainability.
 
Successfully gathering a deeper understanding of how to engage patients and get them to follow through on clinical recommendation requires effort. Telehealth start-ups should routinely engage in pilot testing of their program, starting with primary (in-person) patient interviews, sometimes called contextual patient inquiry. They should then review secondary data, which could include, for example, watching patient video diaries. For example, Sherpa Health and Snap MD, among other, incorporate some of these features as part of their platforms. In addition, we suggest testing “off-the-shelf” telehealth applications in this way on your own populations. Organizations should than modify their approach based on this data to drive patient satisfaction and engagement, which ultimately helps drive the viability and profitability of a telehealth program. A study at Thomas Jefferson University in Philadelphia examined patient perceptions of telehealth, and the findings shed light on video visit characteristics that are important to patients, furthering the case for development of patient-centered outcome measures of satisfaction with telehealth encounters.
 

2) DESIGN FOR MEANINGFUL USE AND CLINICAL VALUE

Telehealth programs need to be aligned for meaningful and clinical value, as well as transparency. Telehealth models often involve physician-patient interactions, such as mobile health apps on patients' phones, or interactive implantable devices. Not surprisingly, these interactions require careful vetting for both HIPAA-based privacy concerns as well as, paradoxically, the ability to share data across the care continuum with all appropriately credentialed providers. The use of password protection for all HLA 7 interfaces with other health records is essential. The interfaces also need to be designed to be compatible with the overwhelming spread of electronic health records. A 2014 Truven Health Analytics survey indicated there were more than 100 electronic medical records (EMRs) commercially available in the U.S. Most providers, however, use one of only four EMRs that command the lion’s share of the market. Design compatibility is critical for interactions with the major EMRs, including interoperable transmission between the various EMRs. Telehealth programs that require unique software bridges to interface with other EMRs are, therefore, less ideal as they incur repetitive costs each time a health system purchases a new software application. The advent of linear artificial intelligence-based software capable of entering disparate databases and allowing them to exchange data may ultimately obviate the need for such bridging software. Use of those “meaningfully useful” programs has thus far been a requirement for successful value-based purchasing and the approval of patient-centered medical homes, but even those systems deemed to be meaningfully compliant with federal requirements have not attained the levels of interoperability necessary to truly be deemed “interactive” and “interoperable.”
 
Reaching those levels through software advances will be crucial for telehealth systems to successfully facilitate cost-effective, high-quality, triple aim compliant care across the continuum and within ACOs and bundled payment programs. Recently, New York-Presbyterian’s telehealth program employed systems matched with telehealth to improve care for their transplant patients. Linear AI programs such as mHealthCoach can track patient care and appointments, including telemedicine appointments from hospitals, primary care and specialist care, and even advise both patients and physicians when lab tests and prescription refills are due. Such programs have already begun to demonstrate their usefulness in improving patient health and lowering costs.
 

3) DESIGN FOR EFFECTIVE POPULATION HEALTH MANAGEMENT

Telehealth can be key to managing chronic conditions as a part of executing effective population health management. It can be especially beneficial for the elderly population (those aged 65+), with the potential to reach 50 million in the U.S. and 1.6 billion in the world by 2050. Serving seniors with multiple chronic diseases such as cancer, diabetes, cardiovascular diseases, and who are enrolled in dual-eligible programs like PACE and Medicare Advantage programs, requires a high degree of data fluidity across the care continuum. Successful implementation of telehealth and alignment with data analytics and IT infrastructure will be foundational for some activities related to chronic disease management, including care coordination, home monitoring and the integration of patient-generated health data into the comprehensive electronic health records. Telehealth can also be an important strategy forimproving patient engagement and enhancing patient compliance by reducing no-shows.
 

4) DESIGN FOR REIMBURSEMENT AND EVOLVING PAYMENT MODELS

Telehealth is trending towards increased coverage from Medicare, Medicaid and private insurance. A sure sign is the recent announcement by HHS’s Office of Inspector General that it would review Medicare Payments for telehealth services. There are active debates in states to extend payment of telehealth services for Medicaid members where telehealth is included for better coverage from Medicare. As organizations transition to value-based payment models, telehealth will prove to be a critical pillar in enabling cost-effective and safe provision of value-based care. A recent announcement from the U.S. Department of Veterans Affairs to expand telehealth services for veterans demonstrates the federal government’s recognition of the significance of telehealth services in delivering access to care. Additionally, while CMS is scaling back the previously mandatory Comprehensive Joint Replacement Program, it is expanding acceptance of payments for Telehealth Services in bundled payment models. To drive return on investment in telehealth, it is critical to plan and design your organization’s functions, such as finance, billing, IT and human resources in such a way to launch and operate under changing payment reforms. It is also important to realign the clinical measures and drivers in the context of payment reform. There are no silos for care and payment in a value-based world.

It’s also key that those systems have the appropriate threshold of financially rewarding payer mix distribution, all in an effort to universally capitalize on the full value of telehealth.

Telehealth is at a point where it can now derive value for the entire organization. All key stakeholders in the healthcare ecosystem are on board: patients prefer it, physicians need it, the market demands it, insurers reimburse for it—and the technology has been proven and is ready to scale.

Typically, adoption has been driven by the physicians, who see telehealth as a way to either see more patients or to see patients who need treatment, not when dictated by rounding schedules. As effective as remote care consultations are, however, healthcare organizations are not yet fully on board—and therefore aren’t maximizing the potential financial benefits of telehealth. To derive value and gain competitive advantage, leaders at healthcare systems need to support end-users and scale up their telehealth programs to incorporate telemedicine as part of their larger organizational strategy with these five key elements in mind.